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24‐hour pH‐impedance monitoring on therapy to select patients with refractory reflux symptoms for antireflux surgery. A single center retrospective study
Author(s) -
Desjardin M.,
Luc G.,
Collet D.,
Zerbib F.
Publication year - 2016
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12715
Subject(s) - reflux , medicine , refractory (planetary science) , heartburn , proton pump inhibitor , esophageal ph monitoring , gastroenterology , single center , retrospective cohort study , prospective cohort study , surgery , gerd , disease , physics , astrobiology
Background Treatment of gastro‐esophageal reflux refractory symptoms is challenging. This monocenter retrospective study assessed the value of preoperative pH‐impedance monitoring ‘on’ therapy to predict functional outcome after laparoscopic fundoplication in patients with refractory reflux symptoms. Methods Patients with a preoperative pH‐impedance monitoring ‘on’ proton pump inhibitors ( PPI s) twice daily were assessed at least 6 months after a laparoscopic fundoplication for refractory reflux symptoms. Failure of fundoplication was defined by a Visick score > 2. Postoperative symptoms were assessed by the reflux disease questionnaire ( RDQ ). The pH‐impedance parameters analyzed were the number of reflux events (total, acid, non‐acid), esophageal acid exposure time, esophageal bolus exposure time, and symptom‐reflux association defined by symptom index ( SI ) >50% and symptom association probability ( SAP ) >95%. Key Results Thirty‐three patients (18 female patients, median age 46 years) were assessed after a mean follow‐up of 41.3 (range 7–102.2) months. Seven (21.2%) patients were considered as failures. Compared to patients with favorable outcome, these patients were more often ‘on’ PPI therapy (86% vs 23%, p < 0.05) and had higher RDQ scores in each domain: heartburn ( p < 0.05), regurgitation ( p < 0.05) and dyspepsia ( p < 0.05). A positive SAP was the only pH‐impedance parameter statistically associated with successful postoperative outcome ( p = 0.004). Conclusions & Inferences On therapy, a preoperative positive symptom association probability is the only pH‐impedance parameter associated with favorable outcome after laparoscopic fundoplication for refractory reflux symptoms. These results should be confirmed by prospective studies.